Can Ketamine Fight Depression?

Special K is not just a breakfast cereal and party drug.

Also known as ketamine, it has long been used as an anesthetic in short term diagnostic and surgical procedures. But Special K is now driving a significant debate in mental health circles because a growing number of psychiatrists in the United States and elsewhere are using it to combat depression.  

According to Andrew Pollack in the New York Times, “it is either the most exciting new treatment in years” or it’s a “hallucinogenic drug that is wrongly being dispensed to desperate patients.”

There is still a decided lack of data necessary for any rational, evidence-based decision. At this stage, the jury isn’t even out. Yet, leading medical centers, including the National Institute of Health, Yale, and Oxford are proposing that low-dose ketamine for major depression has tremendous potential.  It has become, according to Scientific American, a rising star in the world of depression research.

Patrick Cameron, from Toronto, would agree. In 2013-2014, he traveled to New York City on various occasions to visit private clinics for doses of ketamine, all in an effort to relieve his suffering from intractable depression. “This is the only thing that’s worked,” he noted. “I might have finally found the answer.”

However, the question of ketamine’s efficacy remains controversial and, as a result, it constitutes not only another drug in a long line of contested medicines for depression, but a further example of the struggle recreational drugs face in traversing the blurry line of stigmatization and legitimacy.

A 1960s Drug for a Predominant Problem

Originally synthesized in the 1960s, ketamine acted as an alternative to phencyclidine (PCP or “angel dust”) and users often found it produced altered physical, spatial, and temporal states. It grew as a recreational drug and, along with MDMA (Ecstasy) was bound up in rave culture.

By 2006, the National Institute of Mental Health had initiated the first controlled study of ketamine for treating depression. A virtual tidal wave of studies followed, many of which were promising. In the U.K., the lead researcher of an Oxford-based study of 28 people was effusive. “It really is dramatic for some people,” said Dr. Rupert McShane, “it’s the sort of thing that really makes it worth doing psychiatry.”

At the same time, the pharmaceutical industry has demonstrated interest in bringing ketamine products to the medical marketplace. AstraZeneca tried, and then dropped developing a drug, whereas Johnson & Johnson is in the midst of trials for a nasal spray containing esketamine, a ketamine derivative. There are other companies currently seeking to cash in on ketamine.

Yet, psychiatrists in the U.S. are waiting for neither the scientific community nor the pharmaceutical industry to act. Rather, some have begun to establish clinics. With the ability to use ketamine off-label, some American doctors are charging patients like Patrick Cameron $3,000 for six IV infusions of the drug.

With ketamine not yet available in Canada, Cameron, who has opted not to undergo Electroconvulsive Therapy (ECT), is stuck for options.  Canada may have adopted a universal healthcare model, but physicians – without a license from Health Canada – are restricted from offering ketamine as an alternative. So, when Zoloft or Lexapro fail and Canadian citizens choose to skip the electroshock route, they are forced elsewhere.

Much like HIV/AIDS activists in the 1980s, such as Ron Woodroof in Dallas Buyers Club, these Canadians have hard, very personal, and sometimes expensive choices to make as health consumers in the medical marketplace.

Debate Abounds

As in the case of LSD’s revival in mental health or the use of heroin as a therapeutic agent, there has been some resistance to psychiatrist’s administering ketamine.

For Stanford’s Alan F. Schatzberg, it is crucial to be wise about ketamine. “Until we know more,” he cautions, “clinicians should be wary about embarking on a slippery ketamine slope.”

More specifically, the warnings about ketamine clinic usually take three paths. First, severely depressed patients have trouble weighing the risks and rewards associated with experimental therapies. Second, many clinics are run by anesthesiologists, who offer limited psychiatric treatment. Third, the rise of ketamine has detracted from the well-understood Electroconvulsive Therapy (ECT), which has, in many psychiatrist’s view, a proven track-record of success.  

These criticisms, of course, have their merits and faults. But in a larger sense, the discussion about ketamine crystallizes how the public, scientific community, and regulatory bodies in the U.S., Canada, and beyond struggle to negotiate the line separating licit and illicit drugs.

Ketamine is not the same as medical marijuana, or LSD, or heroin as a treatment for addiction. Indeed, Special K does not come with all the baggage as these other drugs and, as an anesthetic, has actually been a valuable tool within mainstream medicine.

As Scientific American wrote earlier this year, “new thinking is desperately needed to aid the estimated 14 million American adults who suffer from severe mental illness.” The approach to ketamine in the United States and Canada is a useful place to start developing that fresh thought.

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